Competency Application Form
Name:
Position Applied For: Staff Grade Occupational Therapist
Closing Date: Applications must be received by12.00 pm on Monday 22ndJanuary 2018
How to Apply:To apply for this position please forward a completed Application Form to Renaud Deworst, Manpower Manager Human Resources Department, Our Lady’s Hospice Care Services, Harold’s Cross, Dublin 6W before closing date stated above. Please ensure that you include details of a current daytime contact number and/or e-mail address on your application.
Ensure that you save a copy of this form to your own computer before editing.
For email applications, please forward to
Applications must be submitted in typed format: Arial font, size 10 or written clearly in blockcapitals using black Ink only.
CURRICULUM VITAE WILL NOT BE ACCEPTED
Our Lady’s Hospice Care Services is an Equal Opportunities Employer and welcomes applications from all sections of the community regardless of gender, age, race, religion, marital status, sexual orientation, disability, membership of the travelling community or family status.
Should you have any difficulty in completing this application form, please Human Resources Department, Recruitment Section, Our Lady’s Hospice & Care Services, Harold’s Cross, Dublin 6W, Tel: 01 491 2594, Fax: 497 4639 (email: ), so that we can assist you.
The information which you give on this form will be treated as strictly confidential and all or part may be retained in a computerised system, in which case the Hospice will comply fully with the requirements of the Data Protection Act.
Thank you for your interest in Our Lady’s Hospice & Care Services.
PRIVATE AND CONFIDENTIAL
Position Details:
(Please use block capitals)
Position Applied For:
Where did you see this position advertised?
Personal Details:
Title:
Forename:
Surname:
Home Address:
Contact Number:
Email Address:
Questionnaire Section:
Do you require eligibility to work in Ireland? (please tick) Yes NoIf yes, please provide details:
A level of proficiency in the English language is a requirement of Our Lady’s Hospice & Care Services. Please rate your proficiency in the English language:
Excellent Good Average Fair Poor
* IMPORTANT Your proficiency in spoken English will be assessed during interview.
Have you ever availed of a Redundancy/Early Retirement Scheme within the Public Sector? Yes No
If yes, give full details:
Details of Current Employment:
Start Date:
Employer Name:
Employer Address:
Job Title:
Notice Period:
Duties and Responsibilities of current post:
Previous Employment Details:
Include any training periods completed if appropriate, and any periods of unemployment.
(Continue on a separate sheet if necessary)
Previous Employer 1:
Position:
Job Description:
Employer Name:
Employer Address:
Start Date:End Date:
Reason for Leaving:
Previous Employer 2:
Position:
Job Description:
Employer Name:
Employer Address:
Start Date:End Date:
Reason for Leaving:
Employment History (previous posts)
Please list all further previous posts beginning with the most recent including periods out of employment or training
Name and address of Employer / Job Title / StartDate (mth/yr) / End
Date (mth/yr) / Reason for leaving / Duties
If you have any gap(s) in your career history, please include and explain in the box below:
Essential Criteria
Please refer to the Person Specification for this post in order to complete this section.
Information provided by the Applicant in this section will be used for shortlisting to the next stage of the recruitment process – please ensure you provide clear information on how you meet the EssentialQualifications and Experience criteria for this post.
** Candidates might be required to bring copies of Certificates to Interview
Essential Qualification
Course Name:
Qualification:
Awarding Body:
Institute:
Country:
Duration:weeks/months/years
From Year: To Year:
Result:
Essential Registration
Name: CORU
Registration number:
Registration Date:Renewal Date:
Essential Experience
Relevant post-graduate and/or undergraduate experience in one or more of the following areas: Care of the Older Person, Palliative Care, Rheumatic & Musculoskeletal DiseaseDesirable Criteria
Please refer to the Person Specification for this post in order to complete this section.
Information provided by the applicant in this section may be used for shortlisting to the next stage of the recruitment process – please ensure you provide clear information on how you meet the Desirable Qualification and Experiencecriteria for this post.
Desirable Experience
Evidence of postgraduate participation in research / audit/ project work in relevant clinical area.Are you a Member of a relevant OT professional advisory group? Yes No
If yes, please provide details:
Core Competencies
Please refer to the Person Specification in order to complete this section of the application form.Please choose two of the Core Competencies listed in the Job Description & Person Specification for this post and provide clear examples which demonstrate how you meet these competencies.One example per competency is sufficient and answers must be a maximum of 150 words. Please ensure you provide clear factual information.
Information provided by the Applicant in this section will be used for shortlisting to the next stage of the recruitment process.
Competency 1Competency 2
References
Two references will be required for all vacancies within Our Lady’s Hospice & Care Services.
Please give details of two referees whom we may contact. Please note that we will not contact your referees without first informing you.
Referee 1 must be your current manager to whom you directly report to.Referee 2 must be the person who you reported to in previous positions. This person must have sanctioned and monitored your leave and performance.
Our Lady’s Hospice & Care Services will determine at reference stage if the referees provided are appropriate or if other referees may be requested.
Referee 1 (Employer/Manager/Supervisor)Title: Mr./Mrs./Miss/ Ms./Dr/Other
First Name
Surname
Role/Position
Company
Contact Address
e-mail address
Phone Number
Professional Relationship:
Can we contact this referee prior to interview?
(Please tick answer that applies) / Yes: / No:
Referee 2
Title:Mr./Mrs./Miss/ Ms./Dr/Other
First Name
Surname
Role/Position
Company
Contact Address
e-mail address
Phone Number
Professional Relationship:
Can we contact this referee prior to interview?
(Please tick answer that applies) / Yes: / No:
Equal Opportunities Monitoring:
Our Lady’s Hospice & Care Services is an equal opportunities employer and operates a “Positive Towards Disability” policy. Please indicate if you have any special requirements should you be invited to interview:
Details of Special Requirements:
Important – Canvassing
Any canvassing by or on behalf of candidates may result in disqualification and exclusion from the recruitment process.
Declaration:
I declare that all the particulars furnished in connection with this application are true and that I am aware of the qualifications and particulars for this position. I understand that I will be required to submit documentary evidence in support of any particulars given by me on my application form. I understand that any false or misleading information submitted by me will render me liable to automatic disqualification or render me liable to dismissal, if employed.
**Failure to sign this application if provided in hardcopy format will render it invalid. However, if applying electronically you need to check the box below:
I confirm that I am in agreement with the statement above
Name of Candidate: …………………………………… (Type in full name if applying by e-mail)
Signature: ……………………………………………….Date: ………………………………… (Insert Date)
** Once Application Form is completed, please review and ensure all information is correct. Do not change layout or format. However, please review the document for any unnecessary extra pages etc. and edit for presentation purposes as appropriate.
Recruitment Process:
- Applications submitted after the closing date will not be accepted.
- Applicants will be shortlisted for interview based on the information supplied in the application form at the closing date.
- The criteria for shortlisting are based on the qualification, experience, core competencies and information supplied in the application form.
- Presentation, content, spelling and grammar pertaining to your application form will be assessed as part of the shortlisting stage.
- If the form is illegible or incomplete this will result in disqualification from the process.
- All applicants will be responded to in due course.
If you require further information regarding this organisation, or the role for which you are applying, please contact:
Human Resources Department
Our Lady’s Hospice Care Services
Harold’s Cross
Dublin 6W
Tel: 00 353 1 491 2594
Fax: 00 353 1 497 4639
Email:
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Competency Based Application Form – Staff Grade OT